Fraction of head and neck cancer attributable to tobacco and alcohol in cities of three Brazilian regions

Kfouri, Suely Aparecida; Eluf Neto, José; Koifman, Sérgio; Curado, Maria Paula; Menezes, Ana; Daudt, Alexander Welaussen; Wünsch Filho, Victor

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 • 2018 • https://doi.org/10.1590/1980-549720180005 copy

Fraction of head and neck cancer attributable to tobacco and alcohol in cities of three Brazilian regions

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objectives:

To estimate the fraction of head and neck cancer (HNC) attributable to tobacco and alcohol in cities in the Midwest, Southeast and South regions of Brazil.

Methods:

Case-control study including 1,594 cases of HNC and 1,292 hospital controls. The association of HNC with tobacco and alcohol was estimated by the odds ratio and respective 95% confidence intervals through non-conditional logistic regression, adjusted for age, sex, schooling, consumption of fruits and vegetables, alcohol drinking (to examine the tobacco effect), and tobacco smoking (to examine the alcohol effect). The proportions of HNC attributable to tobacco and alcohol were estimated through the attributable fraction (AF) calculation. Separate estimates were made for Goiânia (Midwest), Rio de Janeiro and São Paulo (Southeast) and Pelotas and Porto Alegre (South).

Results:

The HNC fraction attributable to smoking was slightly higher in Goiânia (AF = 90%) than in cities in the Southeast (AF = 87%) and South (AF = 86%). The HNC fraction attributable to the consumption of alcoholic beverages presented similar and higher results in the cities of Southeast (AF = 78%) and South (AF = 77%) than in Goiânia (AF = 62%).

Conclusion:

The HNC fractions attributable to smoking were more expressive than for alcohol consumption. Although with discrete distinctions between them, the AFs to tobacco smoking and alcohol consumption in HNC observed in the cities of these three Brazilian regions were similar to those obtained in Latin America studies, but they were higher than in other parts in the world.

Keywords:
Tobacco; Alcohol; Head and neck neoplasms; Brazil; Attributable risk

	Goiânia				Rio de Janeiro and São Paulo				Pelotas and Porto Alegre
	Cases		Controls		Cases		Controls		Cases		Controls
	(n = 341)		(n = 239)		(n = 938)		(n = 665)		(n = 315)		(n = 388)
	n	%	n	%	n	%	n	%	n	%	n	%
Sex
Female	65	19.1	47	19.7	135	14.4	145	21.8	43	13.6	78	20.1
Male	275	80.6	192	80.3	803	85.6	520	78.2	272	86.3	310	80.0
Age (years)
˂ 50	75	21.9	79	33.0	238	25.4	205	30.8	73	23.2	77	20.0
50 to 59	117	34.3	77	32.2	309	32.9	203	30.5	112	35.6	135	35.0
60 to 69	102	29.9	58	24.3	264	28.1	166	24.9	85	26.9	107	28.0
70 or more	46	13.5	25	10.5	127	13.5	91	13.7	45	14.3	69	18.0
Schooling
Did not attend school	116	34.0	58	24.2	123	13.1	90	13.5	45	14.3	65	16.7
Up to elementar school	191	56.0	164	68.6	705	75.2	470	70.7	239	75.9	279	71.9
High school / higher education	34	9.9	17	7.1	110	11.7	105	15.8	31	9.8	44	11.4
Consumption of vegetables (per week)
Less than once	169	49.6	68	28.4	409	43.6	274	41.2	120	38.1	149	38.4
At least once	49	14.4	39	16.3	245	26.1	195	29.3	49	15.6	90	23.2
At least twice	123	36.0	132	55.2	283	30.2	194	29.2	144	45.7	149	38.4
Intake of fruits (per week)
Less than once	83	24.3	28	11.7	122	13.0	38	5.7	36	11.4	20	5.1
At least once	258	75.6	211	88.3	811	86.5	624	93.8	277	87.9	368	94.8
Smoking (status)
Non-smoker*	12	3.5	64	26.8	50	5.3	199	29.9	21	6.8	133	34.3
Former smoker*	89	26.1	98	41.0	196	20.9	260	31.0	76	24.1	137	35.3
Smoker	240	70.4	77	32.2	691	73.7	260	39.1	218	69.2	118	30.4
Alcohol consumption (status)
Does not drink	34	10.0	54	22.6	78	8.3	195	29.3	45	14.3	165	42.5
In the past**	132	38.7	85	35.6	326	34.8	204	30.7	93	30.7	102	26.3
Still drinks	174	51.0	100	41.9	534	57.0	265	39.9	177	56.2	121	31.2

Cities	Status	Cases/controls	Crude OR	IC95%	Adjusted* OR	95%CI	p-value*
Goiânia	Non-smoker	12/64	1.0		1.0		< 0.001
	Former smoker	89/98	4.8	(2.4 - 9.6)	3.5	(1.6 - 7.4)
	Smoker	240/77	16.6	(8.5 - 32.4)	13.6	(6.4 - 28.6)
	Total	341/239
Attributable fraction	90%
São Paulo and Rio de Janeiro	Non-smoker	50/199	1.0		1.0		< 0.001
	Former smoker	196/206	3.8	(2.6 - 5.5)	2.3	(1.6 - 3.5)
	Smoker	691/260	10.6	(7.5 - 14.9)	6.6	(4.5 - 9.7)
	Total	938/665
Attributable fraction	87%
Pelotas and Porto Alegre	Non-smoker	21/133	1.0		1.0		< 0.001
	Former smoker	76/137	3.5	(2.0 - 6.0)	3.0	(1.6 - 5.7)
	Smoker	218/118	11.7	(7.0 - 19.5)	8.8	(4.7 - 16.2)
	Total	388/315
Attributable fraction	86%

Cities	Status	Cases/controls	Crude OR	95%CI	Adjusted* OR	95%CI	p-value*
Goiânia	Does not drink	34/54	1.0		1.0		< 0.001
	In the past	132/85	2.5	(1.5 - 4.1)	2.3	(1.2 - 4.3)
	Still drinks	174/100	2.8	(1.7 - 4.5)	2.8	(1.5 - 5.4)
	Total	341/239
Attributable fraction	62%
São Paulo and Rio de Janeiro	Does not drink	78/195	1.0		1.0		< 0.001
	In the past	326/204	4.0	(2.9 - 5.5)	2.9	(2.0 - 4.3)
	Still drinks	534/265	5.0	(3.7 - 6.8)	4.1	(2.9 - 6.0)
	Total	938/665
Attributable fraction	78%
Pelotas and Porto Alegre	Does not drink	45/165	1.00		1.00		< 0.001
	In the past	93/102	3.3	(2.2 - 5.1)	2.9	(1.7 - 4.9)
	Still drinks	77/121	5.4	(3.6 - 8.0)	4.7	(2.8 - 7.9)
	Total	388/315
Attributable fraction	77%

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

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[1] Corresponding author: Suely Aparecida Kfouri. Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública. Avenida Dr. Arnaldo, 715, Cerqueira César, CEP: 01246-904, São Paulo, SP, Brasil. E-mail: suely.kfourisaka@usp.br